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Home My Public Portal About4855 TEMPLE CITY BLVD_Building__ 7G.636A CE4e035-6R APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDREss BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W JENKINS.BUP T OF BUILDING CROSS ST DIST N OR TYPE PROCESS D !Y FOR APPLICANT TO FILL IN ,Jlv� CONST Zf� BUILDING v y ri i/ Q� STATISTICAL CL6991 PICATION SEWER MAP ADDRESS v✓ �(/ �Ly BK PG CLASS NO DWELL UNITS LOT NO J (� BLOCK USE ZONE MAP �1 NO L/V G TRACT -� SPECIAL SIZE OF LOT 3ONDITIONS JC ��Ti NOW ON LOTS _ USE OF eLOG SETBACK FROM 0 y TEL A FRONT PROP LINE OF OWNER / //yJ� NO /1� D TYPE OF EXISTING SETBACK HIGHWAY YARD TOTAL ADDRESS `� HIGHWAY P OMC L �z. 90 6e .-- } - CITY 71-6 . eLDE SETBACK FROM / ARCHITECT OR TEL SID[ PROP LIN[ OF (STREET) ENGINEER NO TYPE 01 [% SETBACK HIGHWAY } YARD - TOTAL DTH ADDRESS HIGHWAY WIDTH FRIM c L CONTRACTOR NOL } _ ]/�+� LIC CORNER CUTOFF YES NO �/ ADDRESS NO LIc Sq C ASS Y SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK o. NEW ADD ALTER REPAIR DEMOLISH N SO FTNO OF NO OF SIZE 2 TORIES FA MI LIF9 USE OF STRUCTURE SIGNATURE OF APPLICANT x mmal VALUATION 6� APPROVALS DATE INSPECT-vwlA AT I[ P CPMT �j �((/ FOUNDATION LOCATION PEES FEES (/ FORMS MATERIALS Af FRAME, FIRE STOPS, 1 HER99Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE I! CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS %UILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR C D F H[ BT TC OF CALIFORNIA RELAT ING TO WORKMEN S C 6A URANCE LATH EXT SIGNATURE OF HOUSE NUMBER COR- PEHMITTEE R CT AND POSTED ADDRESS FINAL PLAN C CB VALIDATION cX No <AeH JOHN F L PRINCIPAL TRRAL EN R PERNIIT V VALIDATION cK .0 GASH LAL02072�- MAY 17230 14.� 17� 2073 MAY17 1 D 29,00^' a CANCELE T Rc 01" PERMIT7E I _ APPLICATION FQB BUILDING PERMIT COUNTY OF LOSfANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION - FOR'APPucANT TO FILL IN ' BUILDRJG ADDRESS I hereby affirm that I have a certificate of consent to self IT1611rB BLVLO ESS r �� or a certificate of Workers Compensation Insurance ora certified - _ .01 Dopy thereof(Sec 3800 Lab C) LP �.( t' LOGILRY PolicyCompany iSIZE OF LOT - NO OF BLOM NOW ON LOT / - ❑ Certified copy is hereby furnished 1 �.,.ti - NEARESir CROSS ST / ❑ Cortlhed Copy is filed with'the county building ITepection' I TRACT BLOC( - LOT NO _department + 1 - I . USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK' O JPoAEO/6 ••• WOCEL /f// CERTIFICATE OF EXEMPTION FROM WORKERS OWN SPECIAL CONDITIONS. - TEL NO (/ COMPENSATION INSURANCE 0M WTRIIN 1000 FT OF SCHOOL? YES 100 (This section need not be completed if the permit a dollars($100)or less) far one hundred +� S, L- ' DISTRICT GROUP TYPE CONST FRE ZONE PROCBY ESSED / P , I certify that m the performance of the work for which Mrs permit CITY shal is issued I l not empty any person In arty manner so as to LL!-.r�+Gv became subject t0 the Workers Compensation Laws ARCHITE OR ENGINEER - TEL NO SVSISTICAL CLASSI TION APT CONDO Date Applicant ADDRESS _ CLASS NO � DWELL UNITS NOTCE TO AFPLAC4NT If after making the Certificate of REOUIRED TOTAL SETBACK FROM EX16T Exemption you should became Subject to the Workers TEL NO SET BACK YARD I M4Y PROP LINE WIDTH Compensation prawslans Of the Labor Code you must forthwithr 42d FRONT comply with such provisims or the permit shall be deemed revoked ADDRESS P L LICENSED CONTRACTORS DECLARATION t SIDE Jvc P L I hereby affirm that I am licensed underproveions of Chapter 9 42 3 C (commencing with Section 7000)of DNeion 3 of the Business and $0 FT SIZE NO OF STORIES NO OF FAMILIES SENDER MNP Professions Code and my license Is In full force and effect I I NEW ❑ SK - PG loo. dQ License Number LIc Class DESCRIPTION OF NARK ADD ❑ VALUAT1 V Contractor Date- ALTER ❑ $ ((Ucc ❑ 1 am exempt under Sec REPAIR ❑ $ 1 F BSPC for the reason - U Date USE OF EXISTING DEMOL LOW PIC♦ r'�4.1� .i Signature URM Z APPLICANT lPTiNiJ TEL NO LDM4 Prm e ❑ 1 SS Owner Of the property or my employees with wages as _ = 1 iI En (hem sole cornpertsat will do the work and the structure is ADDRESS F {UTI1L � .F+i'- - �c not intended or offered for sale (Section 7044 B amass and FINAL DATE Professions Code) 0 { p VIl1 THE APPuoAHt OR FUNIL1 IS 1.LYiO OCCUfMNi HANq.E A HAZAROW9 MATERMI .5---.;0- o— 4�8J ] -HECK •1;;4•T r ❑ 1 as owner Of the property am exclusrvay contracting with OR n MIXTURE COHTANNG A HATA1001A 4ArERA_EQUAL TO OR GREATER TI WI 711 Q licensed contractors t0 Construct the project (Sect 7044 AAIOIWTs SPE D ON 11E HALw00u9 MATERAL9 iWORwmoxj OUNE9 RNAL Business and Profes5lorla Code) WS❑ NO❑ HAh 3E W1 nE NTE1DEp USE CF THE BWDuW 9Y THE APRIGNT OR FUTURE BUIOtA sournr CONSTRUCTION LENDING AGENCY COAST �E A AE TR fr FORONST�tRlcr escon )i SE "cMTrnlo�r !JST FORc owEUHEs QI]I�—I?I�I)1 4•?7/'i I hereby affirm that there is a construction lending agency for YES❑ No ,v the performance of the work for which this permit is Issued(Sec m MALE READ T1E HAZAIUCa9 MATEWALSINFORMATKINGIADE AND THE 9GOr.1a PEFfAnTtq 3097 Cry C) ClECX11sr I LMDERSPND Mw REQIIREI.ENrS U iOOi THE COS ANOEIES Coum CODE TIRE T Ll1AP1£R T TO SECTpNa T 4a 100 TMW011 T Ta tip CONCEmlNG HAlARap1S Lender 9 NameMATEfbLLa rEPpneq ANp FOR aeuNNG A PERMn FROM THE 9CN3W v Lenders Address o nxcR w ruMrt I certify that I have read the application and state under penalty 8 *�nty perjurybove information a correct I agree to CDRpIy PC FEE PERMIT FEE /t (/ • /� R r0rces and State laws relahg to buildiTgetry auttze represematrves of the County ISSUANCE FEE ve-mentpned property for inspectionINVESTIGATION FEE TOTPL FEE m SEE REVERSE FOR EXPLANATORY LANGUAGE